Internet-Based Cognitive Behavior Therapy vs. Cognitive Behavioral Group Therapy for Social Anxiety Disorder: A Randomized Controlled Non-inferiority Trial

Background and Aims: Cognitive behavioral group therapy (CBGT) is an effective, well-established, but not widely available treatment for social anxiety disorder (SAD). Internet-based cognitive behavior therapy (ICBT) has the potential to increase availability and facilitate dissemination of therapeutic services for SAD. However, ICBT for SAD has not been directly compared with in-person treatments such as CBGT and few studies investigating ICBT have been conducted in clinical settings. Our aim was to investigate if ICBT is at least as effective as CBGT for SAD when treatments are delivered in a psychiatric setting. Methods: We conducted a randomized controlled non-inferiority trial with allocation to ICBT (n = 64) or CBGT (n = 62) with blinded assessment immediately following treatment and six months post-treatment. Participants were 126 individuals with SAD who received CBGT or ICBT for a duration of 15 weeks. The Liebowitz Social Anxiety Scale (LSAS) was the main outcome measure. The following non-inferiority margin was set: following treatment, the lower bound of the 95 % confidence interval (CI) of the mean difference between groups should be less than 10 LSAS-points. Results: Both groups made large improvements. At follow-up, 41 (64%) participants in the ICBT group were classified as responders (95% CI, 52%-76%). In the CBGT group, 28 participants (45%) responded to the treatment (95% CI, 33%-58%). At post-treatment and follow-up respectively, the 95 % CI of the LSAS mean difference was 0.68-17.66 (Cohens d between group = 0.41) and -22.51-15.69 (Cohens d between group = 0.36) favoring ICBT, which was well within the non-inferiority margin. Mixed effects models analyses showed no significant interaction effect for LSAS, indicating similar improvement across treatments (F = 1.58; df = 2, 219; p = .21). Conclusions: ICBT delivered in a psychiatric setting can be as effective as CBGT in the treatment of SAD and could be used to increase availability to CBT.Original Publication:Erik Hedman, Gerhard Andersson, Brjann Ljotsson, Erik Andersson, Christian Ruck, Ewa Mortberg and Nils Lindefors, Internet-Based Cognitive Behavior Therapy vs. Cognitive Behavioral Group Therapy for Social Anxiety Disorder: A Randomized Controlled Non-inferiority Trial, 2011, PLOS ONE, (6), 3, .http://dx.doi.org/10.1371/journal.pone.0018001Licensee: Public Library of Science (PLoS)http://www.plos.org

Hypoxia Due to Cardiac Arrest Induces a Time-Dependent Increase in Serum Amyloid β Levels in Humans

Amyloid β (Aβ) peptides are proteolytic products from amyloid precursor protein (APP) and are thought to play a role in Alzheimer disease (AD) pathogenesis. While much is known about molecular mechanisms underlying cerebral Aβ accumulation in familial AD, less is known about the cause(s) of brain amyloidosis in sporadic disease. Animal and postmortem studies suggest that Aβ secretion can be up-regulated in response to hypoxia. We employed a new technology (Single Molecule Arrays, SiMoA) capable of ultrasensitive protein measurements and developed a novel assay to look for changes in serum Aβ42 concentration in 25 resuscitated patients with severe hypoxia due to cardiac arrest. After a lag period of 10 or more hours, very clear serum Aβ42 elevations were observed in all patients. Elevations ranged from approximately 80% to over 70-fold, with most elevations in the range of 3–10-fold (average approximately 7-fold). The magnitude of the increase correlated with clinical outcome. These data provide the first direct evidence in living humans that ischemia acutely increases Aβ levels in blood. The results point to the possibility that hypoxia may play a role in the amyloidogenic process of AD

Assessment of the Cerebral Ischemic/Reperfusion Injury after Cardiac Arrest

The cerebral damage after cardiac arrest is thought to arise both from the ischemia during the cardiac arrest but also during reperfusion. It is the degree of cerebral damage which determines the outcome in patients. This thesis focuses on the cerebral damage after cardiac arrest. In two animal studies, positron emission tomography (PET) was used to measure cerebral blood flow, oxygen metabolism and oxygen extraction in the brain. After restoration of spontaneous circulation (ROSC) from five or ten minutes of cardiac arrest there was an immediate hyperperfusion, followed by a hypoperfusion which was most evident in the cortex. The oxygen metabolism decreased after ROSC with the lowest values in the cortex. The oxygen extraction was high at 60 minutes after ROSC, indicating an ischemic situation. After ten minutes of cardiac arrest, there was a hyperperfusion in the cerebellum. In 31 patients resuscitated after cardiac arrest and treated with hypothermia for 24 hours, blood samples were collected from admission until 108 hours after ROSC. The samples were analyzed for different biomarkers in order to test the predictive value of the biomarkers. The patients were assessed regarding their neurological outcome at discharge from the intensive care unit and after six months. Brain derived neurotrophic factor (BDNF) and glial fibrillary acidic protein (GFAP) was not associated with outcome. Neuron specific enolase (NSE) concentrations were higher among those with a poor outcome with a sensitivity of 57% and a specificity of 93% when sampled 96 hours after ROSC. S-100B was very accurate in predicting outcome; after 24 hours after ROSC it predicted a poor outcome with a sensitivity of 87% and a specificity of 100%. Tau protein predicted a poor outcome after 96 hours after ROSC with a sensitivity of 71% and a specificity of 93%

Is dithered truncation preferred over pure truncation at a bit depth of 16-bits when a digital re-quantization has been performed on a 24-bit sound file?

This essay has been looking at dither in digital audio from a listeners perspective, in order to find out if the final consumer can hear any difference between dithered truncation and pure truncation.Validerat; 20101217 (root

En jämförelse av lokalrapportering från Svenska och Norska val.

Titel: Andra rangens val, andra rangens rapportering? En jämförelse av lokalrapportering från Svenska och Norska val. Författare: Erik Westergren-Mörtberg Kurs: Examensarbete i Medie- och kommunikationsvetenskap, Institutionen för journalistik och masskommunikation vid Göteborgs Universitet Termin: Höstterminen -10 Handledare: Bengt Johansson Antal ord: Ca 18000 ord. Syfte: Att genom en jämförelse av Svenska och Norska dagstidningars innehåll dagarna före ett lokalval, avgöra hur gemensam respektive separata valdagar påverkar lokaltidningarnas rapportering om lokalpolitiska frågor. Metod: Kvantitativ metod. Textanalys av 630 artiklar från fyra tidningar från Sverige och Norge. Material: Samtliga politiska artiklar från 14 nummer av fyra tidningar. Totalt 630 artiklar från 56 nummer fördelade över fyra tidningar, två från Sverige och Två från Norge. Från Sverige: Skaraborgs Allehanda Borås Tidning Från Norge: Romerikes Blad Fedrelandsvennen Resultat: Studien visar att de norska tidningarna prioriterar kommunalvalet högre än de svenska tidningarna. Det kommunala materialet är större, högre prioriterat och mer synligt i de norska tidningarna. Fördelningen och prioriteringen av sakfrågor är ungefär densamma i samtliga tidningar och visar på en låg nivå av inblandning från rikspolitiska frågor i lokalpolitiken, men större fokus på rikspolitiska frågor i artiklar med svenska lokalpolitiker

Shame and guilt in social anxiety disorder: effects of cognitive behavior therapy and association with social anxiety and depressive symptoms.

Social anxiety disorder (SAD), characterized by fear of being scrutinized by others, has features that that are closely linked to the concept of shame. Despite this, it remains to be investigated whether shame is elevated in persons with SAD, and if cognitive behavior therapy (CBT) for SAD could reduce shame experience. In the present study, we focused on internal shame, i.e. the type of shame that pertains to how we judge ourselves. Although guilt is distinctly different from shame, we also viewed it as important to investigate its role in SAD as the two emotions are highly correlated. The aim of this study was to investigate: (I) if persons with SAD differ from healthy controls on shame and guilt, (II) if shame, guilt, depressive symptoms, and social anxiety are associated in persons with SAD, and (III) if CBT can reduce internal shame in patients with SAD. Firstly, we conducted a case-control study comparing a sample with SAD (n = 67) with two samples of healthy controls, a main sample (n = 72) and a replication sample (n = 22). Secondly, all participants with SAD were treated with CBT and shame, measured with the Test of Self-Conscious affect, was assessed before and after treatment. The results showed that shame was elevated in person with SAD compared to the control replication sample, but not to the main control sample. In addition, shame, social anxiety, and depressive symptoms were significantly associated among participants with SAD. After CBT, participants with SAD had significantly reduced their shame (Cohen's d = 0.44). Guilt was unrelated to social anxiety. We conclude that shame and social anxiety are associated and that it is likely that persons with SAD are more prone to experience shame than persons without SAD. Also, CBT is associated with shame reduction in the treatment of SAD

Demographic description of the participants.

<p><i>Abbreviations:</i> SAD, social anxiety disorder; HC-M, Healthy controls-main sample; HC-R, Healthy controls, replication sample;</p>*<p> = significant at alpha-level .05.</p

Means, SDs and effect sizes on measures of shame, guilt, social anxiety and depressive symptom.

<p>Abbreviations: TOSCA, Test of Self-Conscious Affect; LSAS-SR, Liebowitz Social Anxiety Scale-Self report; SIAS, Social Interaction Anxiety Scale; BDI, Beck Depression Inventory, Post, Post-treatment; SAD, Social anxiety disorder; HC-M, Healthy controls-main sample; HC-R, Healthy controls-replication sample. Note: all between group analyses conducted on baseline scores; follow-up scores collected at one-year follow-up;</p>*<p> = significant at <.05;</p>**<p> = significant at <.01.</p

Intercorrelations on measures of shame, guilt, social anxiety and depressive symptoms for participants with SAD.

<p>Abbreviations: TOSCA, Test of Self-Conscious Affect; LSAS-SR, Liebowitz Social Anxiety Scale-Self report; SIAS, Social Interaction Anxiety Scale; BDI, Beck Depression Inventory. Note:</p>a<p>partial correlations represent associations between TOSCA and social anxiety scales controlling for BDI scores and vice versa;</p>*<p> = significant at <.05;</p>**<p> = significant at <.01. All correlations are based on data collected before treatment.</p